| NPI | 1558361857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810002048) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: DC PSY1000052) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2008-08-12 |