| NPI | 1588858187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN 6160) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA 23694) |
| 103G00000X Clinical Neuropsychologist (Licence: WI 2853-057) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2018-03-17 |