| NPI | 1013059310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 009089) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY-0005327) |
| 103TC0700X Psychologist, Clinical (Licence: NY 009089) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY-0005327) | |
| 103TF0200X Psychologist, Forensic (Licence: NY 009089) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY-0005327) | |
| 103T00000X Psychologist (Licence: NY 009089) | |
| 103T00000X Psychologist (Licence: FL PY-0005327) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |