| NPI | 1417001819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 3624) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY 21292) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2008-11-19 |