| NPI | 1578727855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WY 440) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WY 440) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2009-08-28 |