| NPI | 1700070489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 4056) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: AZ 3313826) |
| 103G00000X Clinical Neuropsychologist (Licence: AZ 4056) | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2009-10-14 |