| NPI | 1275630600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: SC 614) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: SC 614) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-12 |