| NPI | 1487606497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO 1083) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO 1083) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-08-27 |