| NPI | 1336390863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN P2984) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 8906) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2012-07-12 |