| NPI | 1417901885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MO RO299) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO R0299) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2013-08-16 |