| NPI | 1780648022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 2677-057) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 2677-57) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2014-03-25 |