| NPI | 1447426119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NM 516) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: NM 516) |
| 103TH0004X Psychologist Health (Licence: NM 516) | |
| 174400000X Specialist | |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2008-05-02 |