| NPI | 1164620969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY5159) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: FL PY5159) |
| 171M00000X Case Manager/Care Coordinator (Licence: FL PY5159) | |
| 103G00000X Clinical Neuropsychologist | |
| 103TA0700X Psychologist, Adult Development & Aging | |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2010-08-18 |