| NPI | 1609801521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY5700) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 2252) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-02-04 |