| NPI | 1285614370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AL 661) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MS 46805) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2007-07-09 |