| NPI | 1578570735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: RI 205) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 2659) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |