| NPI | 1588954200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: KS 1951) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MO 2008007983) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-04-14 |