| NPI | 1063523678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY4878) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY4878) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-02-18 |