| NPI | 1184790560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IA 00217) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 00631) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2010-12-15 |