| NPI | 1669646659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NM 641) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO 1943) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-04-22 |