| NPI | 1710177357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: UT 11569209-2501) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 001037) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2021-03-04 |