| NPI | 1659710069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY 1715) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: DC PSY 1715) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2013-06-19 |