| NPI | 1184004616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY 9176) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY9176) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2015-09-21 |