| NPI | 1750426243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: ME PS848) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 3286) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: ME PS848) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MA 3286) | |
| 103TC0700X Psychologist, Clinical (Licence: ME PS848) | |
| 103TC0700X Psychologist, Clinical (Licence: MA 3286) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2010-12-22 |