| NPI | 1174817498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 05119) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2013-07-08 |