| NPI | 1730148925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: TX 25025) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 25025) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2017-02-27 |