| NPI | 1043306723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: LA 681) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: LA 681) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2014-10-02 |