| NPI | 1215989991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10260) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 2561) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-10-12 |