| NPI | 1740218015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 1260) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OR 1260) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2011-01-12 |