| NPI | 1992853402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OR 978) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 0978) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2018-04-09 |