| NPI | 1235100835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810001380) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810001380) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2016-01-04 |