| NPI | 1215047428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 4608) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 4608) |
| 103TF0000X Psychologist, Family (Licence: MA 4608) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: MA 4608) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-12-16 |