| NPI | 1629114699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 04253) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MD 04253) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2016-09-27 |