| NPI | 1659506269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 5041) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: ME PS1323) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2016-11-23 |