| NPI | 1104293109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY10205) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY10205) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2024-05-07 |