| NPI | 1780008425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810007683) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: KS 2664) |
| 103G00000X Clinical Neuropsychologist (Licence: FL PY10480) | |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2025-01-30 |