| NPI | 1346347242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WI 3042) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AR 983P) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-09-16 |