| NPI | 1376893032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AL 555) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 555) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2014-05-14 |