| NPI | 1366504136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: SC 976) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 02138) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2016-05-16 |