| NPI | 1750394953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IA 00650) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IA 00650) |
| 103TH0004X Psychologist Health (Licence: IA 00650) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2024-04-12 |