| NPI | 1407905284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OK 636) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OK 636) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2011-12-28 |