| NPI | 1285866558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 3784) |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2009-08-19 |