| NPI | 1003981986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY6981) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY6981) |
| Enumeration Date | 2006-11-23 |
| Last Update Date | 2020-04-28 |