| NPI | 1871673269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 4195) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: MA 4195) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2010-03-04 |