| NPI | 1144315086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 4264) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 4264) |
| 103TC0700X Psychologist, Clinical (Licence: OH 4264) | |
| 103TH0100X Psychologist, Health Service (Licence: OH 4264) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: OH 4264) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2013-11-15 |