| NPI | 1568433365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810000976) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810000976) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2015-09-16 |