| NPI | 1700995677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MO 01173) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MO 01173) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-17 |