| NPI | 1205145174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY8167) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY8167) |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2022-11-01 |