| NPI | 1245245117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO 2846) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301006649) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2009-11-10 |