| NPI | 1346248200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 002279) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: CT 002279) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2007-07-08 |