| NPI | 1679516645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 002567) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 015711-1) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2013-02-28 |