| NPI | 1033431317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 9201) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CT 3000) |
| Enumeration Date | 2010-02-27 |
| Last Update Date | 2011-07-18 |