| NPI | 1861524241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 2415) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810002498) |
| 103G00000X Clinical Neuropsychologist (Licence: DE B1-0001108) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2020-03-26 |