NPI | 1215937826 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: FL PY0004169) |
Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: FL PY0004169) |
103G00000X Clinical Neuropsychologist (Licence: FL PY0004169) | |
103T00000X Psychologist (Licence: FL PY0004169) | |
Enumeration Date | 2005-07-26 |
Last Update Date | 2025-09-11 |