| NPI | 1568613073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NH 914) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VT 759) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NH 914) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VT 759) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2008-10-02 |