| NPI | 1437389871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NM 0967) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NM 0967) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2012-06-05 |