| NPI | 1952365462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO 1152) |
| Additional Taxonomies | 103TH0004X Psychologist, Health |
| 103TH0100X Psychologist, Health Service | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2023-01-11 |