| NPI | 1255406013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 8578) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 8578) |
| 103G00000X Clinical Neuropsychologist (Licence: MA 8578) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2010-07-15 |