| NPI | 1053314344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 1715) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 1715) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2014-04-23 |