| NPI | 1457349516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY5114) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL PY5114) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2016-05-23 |