| NPI | 1295789980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301010565) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IN 20040647A) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2008-05-15 |