| NPI | 1366842999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810005434) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: VA 0810005434) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2018-03-17 |