| NPI | 1982108163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MO 2017002021) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: MO 2017002021) |
| 103TR0400X Psychologist Rehabilitation (Licence: MO 2017002021) | |
| 103TC0700X Psychologist Clinical (Licence: MO 2017002021) | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2021-07-23 |