| NPI | 1659456903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 1228) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OH P.1228) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2022-01-04 |