| NPI | 1174585202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 3804) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 3804) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2022-06-30 |