| NPI | 1992897169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO PY01810) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MO PY01810) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2020-04-22 |