| NPI | 1134345523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OR 826) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OR 826) |
| 103TR0400X Psychologist Rehabilitation (Licence: OR 826) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-07-09 |