| NPI | 1093778573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 02725) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: MD 02725) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2007-07-10 |