| NPI | 1528147774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IA 00151) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 00493) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2008-02-26 |