| NPI | 1316008303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WI 820) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: WI 820) |
| 103TR0400X Psychologist, Rehabilitation (Licence: WI 820) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-07-08 |