| NPI | 1093954133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 9390) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY22495) |
| 103G00000X Clinical Neuropsychologist (Licence: CT 003128) | |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2017-03-06 |