| NPI | 1184885535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO 3131) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO 3131) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2013-05-16 |