| NPI | 1265448120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 2557) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 9165) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2010-06-07 |