| NPI | 1972792802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO 3515) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 797) |
| 103TC0700X Psychologist, Clinical (Licence: CO 3515) | |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2013-07-08 |