| NPI | 1093763161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY4623) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NV PY0591) |
| 103T00000X Psychologist (Licence: NV PY0591) | |
| 103T00000X Psychologist (Licence: FL PY4623) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY4623) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY4623) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2019-06-11 |