| NPI | 1295750636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MT 226) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MT PSY-PSY-LIC-226) |
| 103TS0200X Psychologist, School (Licence: MT 59040) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2019-09-11 |