| NPI | 1265655138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 1139) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AZ 1139) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: AZ 1139) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |