| NPI | 1114011558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 1212) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO 1212) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-08-18 |