| NPI | 1558481184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2011-06-13 |