| NPI | 1831754050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ PSY-005009) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 5009) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2024-10-16 |