| NPI | 1952392755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 3899) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ 3899) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2009-10-07 |