| NPI | 1326035734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NH 785) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 6782) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2007-07-08 |