| NPI | 1982765483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 05169) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810007291) |
| 103G00000X Clinical Neuropsychologist (Licence: FL PY7178) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2021-01-19 |