| NPI | 1679520092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810001696) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103G00000X Clinical Neuropsychologist (Licence: VA 810001696) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2017-10-24 |