| NPI | 1639278567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: SC 567) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: SC 567) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2008-01-09 |