| NPI | 1962535559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810003733) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810003733) |
| 235Z00000X Speech-Language Pathologist, (Licence: VA 2202003394) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2009-09-29 |