| NPI | 1427115807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 01627) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 01627) |
| 103G00000X Clinical Neuropsychologist (Licence: MD 01627) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2007-07-08 |