| NPI | 1942424189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 01445) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 07636) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2007-07-08 |