| NPI | 1104861988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OK 584) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OK 584) |
| 103T00000X Psychologist (Licence: OK 584) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2007-10-04 |