| NPI | 1023242898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY9803) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MT 271) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MT 271) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MT 271) | |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2017-02-16 |