| NPI | 1124096920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 3482) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 3482) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2014-09-08 |