| NPI | 1053348441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: ID PSY239) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ID PSY239) |
| 103T00000X Psychologist (Licence: ID PSY-239) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2012-11-13 |