| NPI | 1285685800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MT 268) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MT 268) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-06-10 |