| NPI | 1881807915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 4902) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NH 524) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2013-05-16 |