| NPI | 1336168277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810001047) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: VA 0810001047) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810001047) | |
| 103T00000X Psychologist (Licence: VA 0810001047) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |