| NPI | 1043407661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 048.0067580) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VT 048-0067580) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2013-06-26 |