| NPI | 1588238380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ PSY-005921) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 6659) |
| 103TC0700X Psychologist Clinical (Licence: PR 7637) | |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2025-08-11 |