| NPI | 1649412743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 4039) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 4039) |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2017-03-20 |