| NPI | 1013904309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 4495) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 4495) |
| 103TH0100X Psychologist, Health Service (Licence: MA 4495) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2007-07-09 |