| NPI | 1881149946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN 3816) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 10827) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2022-03-14 |