| NPI | 1982664355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WV 1209) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CT 2647) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2019-02-26 |