| NPI | 1558542118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: UT 5972150-2501) |
| 103TR0400X Psychologist, Rehabilitation (Licence: UT 5972150-2501) | |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2019-04-17 |