| NPI | 1508162066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AR 11-12P) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TN 2911) |
| 103TC0700X Psychologist, Clinical (Licence: TN 2911) | |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2011-08-25 |