| NPI | 1336100957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 416) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: SC 416) |
| 103G00000X Clinical Neuropsychologist (Licence: SC 416) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2014-07-27 |