| NPI | 1578542510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA 2010) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY002010) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2014-06-24 |