| NPI | 1366820565 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 3459) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 3459) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2015-05-08 |