| NPI | 1306043690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 8922) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 8922) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2014-09-15 |