| NPI | 1386857506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 1477) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 1477) |
| 103G00000X Clinical Neuropsychologist | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2009-07-23 |