| NPI | 1306994439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NC 751) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 751) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2010-02-08 |