| NPI | 1952317950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: NM 279) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NM 279) |
| 103G00000X Clinical Neuropsychologist (Licence: NM 279) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2013-09-30 |