| NPI | 1760468300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TN P0000001583) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810001787) |
| 103T00000X Psychologist (Licence: TN P0000001583) | |
| 103T00000X Psychologist (Licence: VA 0810001787) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2007-07-08 |