| NPI | 1639251093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MA 9251) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 9251) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2011-10-22 |