| NPI | 1255375655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 2945) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 2945) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2016-12-30 |