| NPI | 1730269093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 23847) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: KY 1446) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2013-02-19 |