| NPI | 1053327759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MS T55973) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NM 407) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2015-12-16 |