| NPI | 1295800357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 34716) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 016856-1) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2012-10-12 |