| NPI | 1881634277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 00765) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 00328) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2011-01-25 |