| NPI | 1174512644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WI 2470-057) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN LP 0160) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2007-07-08 |