| NPI | 1134153190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: DC PSY1266) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 1682) |
| 103G00000X Clinical Neuropsychologist (Licence: PA PS-7869-L) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2010-05-14 |