| NPI | 1073663555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AL 816) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AL 816) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2009-02-06 |