| NPI | 1619296555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL 9214) |
| Additional Taxonomies | 103TR0400X Psychologist Rehabilitation (Licence: GA PSY003849) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2016-08-19 |