| NPI | 1619112430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00081) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 00081) |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2008-12-08 |