| NPI | 1245608793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY9412) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OR 2513) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2020-05-13 |