| NPI | 1316025240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY 17493) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NJ 35SI00377600) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-02-26 |