| NPI | 1003073875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810000876) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: VA 0810000876) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2008-05-20 |