| NPI | 1639183478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 00893) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 00893) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2011-11-16 |