| NPI | 1316018997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 1925-057) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 1925-057) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2019-10-14 |