| NPI | 1841218443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY10129) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: FL PY10129) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY10129) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: ND 374) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2021-01-18 |