| NPI | 1043297880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY11928) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: RI PS00634) |
| 103G00000X Clinical Neuropsychologist (Licence: RI PS00634) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2024-01-22 |