| NPI | 1336218536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO R0052) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: KS 1281) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2008-11-05 |