| NPI | 1306864319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 7977) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: RI PS00771) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |