| NPI | 1679543433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 1363) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 1363) |
| 103TF0200X Psychologist, Forensic (Licence: NC 1363) | |
| 103TH0004X Psychologist, Health (Licence: NC 1363) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: NC 1636) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2009-05-11 |