| NPI | 1609110808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN 3250) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MO 2012029768) |
| 103TC0700X Psychologist, Clinical (Licence: TN 3250) | |
| Enumeration Date | 2012-11-12 |
| Last Update Date | 2024-05-24 |