| NPI | 1528181047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AL 871) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY 5277) |
| 103TC0700X Psychologist Clinical (Licence: FL PY 5277) | |
| 103TC0700X Psychologist Clinical (Licence: AL 871) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2014-12-12 |