| NPI | 1669754370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AK 112983) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AL 1932) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2016-07-18 |