| NPI | 1497930481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: SD 518) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SD 518) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: SD 518) | |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2015-10-13 |