| NPI | 1720120587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810003887) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: GA 2177) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2022-09-13 |