| NPI | 1700986841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 001864) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 001864) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-09-17 |