| NPI | 1063410405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 3580) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 3580) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2018-01-30 |