| NPI | 1073531463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY7815) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OH 5956) |
| 103T00000X Psychologist (Licence: FL PY7815) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-03-19 |