| NPI | 1669477204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: KS LP1161) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MO 2002007821) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2007-08-13 |