| NPI | 1386763902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WI 2808) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 2808) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2013-03-08 |