| NPI | 1033234950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810002331) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: VA 0810002331) |
| 103TC0700X Psychologist Clinical (Licence: VA 0810002331) | |
| 103TH0100X Psychologist Health Service (Licence: VA 0810002331) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |