| NPI | 1568470292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 3287) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 3287) |
| 103TR0400X Psychologist, Rehabilitation (Licence: OH 3287) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |