| NPI | 1427541549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 07707) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 07707) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2018-09-04 |