| NPI | 1275867921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 9460) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 9460) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2012-01-22 |