| NPI | 1972645026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA MD60620786) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 258121) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2004014337) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2016-02-26 |