| NPI | 1770475956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY0004691) |
| Enumeration Date | 2025-07-21 |
| Last Update Date | 2025-07-21 |