| NPI | 1316920952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY3117) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY5814) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2007-11-28 |