| NPI | 1720024607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY001660) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: KY KY-0862) |
| 103G00000X Clinical Neuropsychologist (Licence: IN 20040782A) | |
| 103T00000X Psychologist (Licence: GA PSY1660) | |
| 103T00000X Psychologist (Licence: KY KY-0862) | |
| 103T00000X Psychologist (Licence: IN 20040782A) | |
| 103TF0200X Psychologist, Forensic (Licence: GA PSY001660) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2007-07-08 |