| NPI | 1124026067 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 000975) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 000975) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2012-07-05 |