| NPI | 1063458123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL 0004643) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL 0004643) |
| 103TH0100X Psychologist, Health Service (Licence: FL 0004643) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2012-10-11 |