| NPI | 1134100761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 6061) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 6061) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2019-01-07 |