| NPI | 1306895677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY00002458) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: ID PSY301) |
| 103G00000X Clinical Neuropsychologist (Licence: UT 276031-2501) | |
| 103G00000X Clinical Neuropsychologist (Licence: WY 436) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2010-11-17 |