| NPI | 1992829022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NE 530) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NE 530) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NE 530) | |
| 103TC0700X Psychologist, Clinical (Licence: NE 530) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-07-09 |