| NPI | 1336132257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO MO00020) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MO MO00020) |
| 103G00000X Clinical Neuropsychologist (Licence: KS KS205) | |
| 103T00000X Psychologist (Licence: KS KS205) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2010-12-20 |