| NPI | 1033241120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 002873) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: RI PS00902) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2008-09-17 |