| NPI | 1437224326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MO Pyro 280) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: KS 809) |
| Enumeration Date | 2006-11-23 |
| Last Update Date | 2008-08-20 |