| NPI | 1255476792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY5723) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY5723) |
| 103TH0100X Psychologist Health Service (Licence: FL PY5723) | |
| 103TR0400X Psychologist Rehabilitation (Licence: FL PY5723) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2008-02-01 |