| NPI | 1972698140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OR 1135) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 1135) |
| 103TF0200X Psychologist, Forensic (Licence: OR 1135) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |