| NPI | 1740351485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IA 00180) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00579) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2008-01-02 |