| NPI | 1740764158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.0004889) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0004889) |
| 103TC0700X Psychologist, Clinical (Licence: FL 10642) | |
| 103TH0004X Psychologist, Health (Licence: CO PSY.0004889) | |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2022-08-02 |