| NPI | 1437272945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: LA 378MP) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 378MP) |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 378MP) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2007-08-30 |