| NPI | 1548349798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 3608) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 3608) |
| 103TH0100X Psychologist, Health Service (Licence: OH 3608) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |