| NPI | 1558575035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 3465) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ 3465) |
| 103TF0200X Psychologist, Forensic (Licence: AZ 3465) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2008-06-16 |