| NPI | 1700802485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AR 01-15P) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AR 01-15P) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2015-06-18 |