| NPI | 1699136085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WI 3356) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN LP5974) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2024-02-16 |