| NPI | 1811976129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WI 2060) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN 5565) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2016-09-21 |