| NPI | 1497846216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 003233) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY5358) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2012-10-19 |