| NPI | 1346288917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY0003426) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810003658) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2023-10-04 |