| NPI | 1669568960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO CO2290) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: CO CO2290) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-10-11 |