| NPI | 1750382388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 798) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NC 798) |
| Enumeration Date | 2005-08-04 |
| Last Update Date | 2012-02-28 |