| NPI | 1932237674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: LA 640) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: LA 640) |
| 103T00000X Psychologist (Licence: LA 640) | |
| 103TR0400X Psychologist Rehabilitation (Licence: LA 640) | |
| 103TC0700X Psychologist Clinical (Licence: LA 640) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2013-09-12 |