| NPI | 1255475646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: DC PSY572) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810000737) |
| 103TF0200X Psychologist, Forensic (Licence: DC PSY572) | |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2007-07-09 |