| NPI | 1841570702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO PSY.0004139) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.0004139) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2016-06-22 |