| NPI | 1205900206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 04034) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 2772) |
| 103G00000X Clinical Neuropsychologist (Licence: CA PSY13584) | |
| 103T00000X Psychologist (Licence: MD 04034) | |
| 103T00000X Psychologist (Licence: NC 2772) | |
| 103T00000X Psychologist (Licence: CA PSY13584) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2012-09-12 |