| NPI | 1699875070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OR 2035) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: OR 2035) |
| 103TC0700X Psychologist, Clinical (Licence: OR 2035) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2016-07-14 |