| NPI | 1487830402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS 006496L) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301011261) |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2008-06-02 |