| NPI | 1134272552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 1140) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 1140) |
| 103T00000X Psychologist (Licence: AZ 1140) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2012-09-28 |