| NPI | 1437545373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: SC 468) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: SC 468) |
| 103TC0700X Psychologist Clinical (Licence: SC 468) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2015-09-24 |