| NPI | 1205863966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 5537) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: OH 5537) |
| 103TC0700X Psychologist Clinical (Licence: OH 5537) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2007-07-08 |