| NPI | 1013943802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810003943) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810003943) |
| 146N00000X Emergency Medical Technician, Basic (Licence: VA B030116102) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2011-08-25 |