| NPI | 1619186467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: KY 0830) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WV 817) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KY 0830) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WV 817) | |
| 103TC0700X Psychologist, Clinical (Licence: KY 0830) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2011-03-22 |