| NPI | 1366675241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO 2301) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OH 4168) |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2020-04-17 |