| NPI | 1780702985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: DC 1384) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 2075) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |