| NPI | 1588668958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WI 1762) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WI 1762) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2014-11-21 |