| NPI | 1326373424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 02659) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810001628) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2009-10-07 |