| NPI | 1538266226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: LA 526) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 526) |
| 103TC0700X Psychologist, Clinical (Licence: LA 526) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2017-04-13 |