| NPI | 1124043419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810002258) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810002258) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2009-08-13 |