| NPI | 1932190279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 8006) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 8006) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2025-11-11 |