| NPI | 1669511564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MO 2006033335) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 2006033335) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2024-04-10 |