| NPI | 1730752924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ PSY-005388) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AZ PSY-005388) |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2022-05-10 |