| NPI | 1285628362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 2796) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 2796) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2020-04-21 |