| NPI | 1295924546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 001051) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 3206) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2007-10-22 |