| NPI | 1407844277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IA 00929) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00424) |
| 103T00000X Psychologist (Licence: IA 00929) | |
| 103T00000X Psychologist (Licence: MN LP1079) | |
| 103T00000X Psychologist (Licence: IL 071006441) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2007-07-09 |