| NPI | 1174880959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL Py 8505) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY 8505) |
| 103G00000X Clinical Neuropsychologist (Licence: GA PSY003602) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2013-09-11 |