| NPI | 1811943830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810000910) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810000910) |
| 103TC0700X Psychologist, Clinical (Licence: MA 2228) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2008-10-16 |