| NPI | 1417143314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MA 6340) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 6340) |
| 103TF0200X Psychologist Forensic (Licence: MA 6340) | |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2010-06-16 |