| NPI | 1205921541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 000795) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CT 000795) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-12-02 |