| NPI | 1225071228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 1218) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY4372) |
| 103TC0700X Psychologist Clinical (Licence: NC 1218) | |
| 103G00000X Clinical Neuropsychologist (Licence: NC 1218) | |
| 103TR0400X Psychologist Rehabilitation (Licence: NC 1218) | |
| 103TC0700X Psychologist Clinical (Licence: FL PY4372) | |
| 103G00000X Clinical Neuropsychologist (Licence: FL PY4372) | |
| 103TR0400X Psychologist Rehabilitation (Licence: FL PY4372) | |
| 103TF0200X Psychologist Forensic (Licence: FL PY4372) | |
| 103TF0200X Psychologist Forensic (Licence: NC 1218) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2008-11-01 |