| NPI | 1629301429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 2411) |
| 103TC0700X Psychologist, Clinical (Licence: WY 482) | |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2018-07-25 |