| NPI | 1366454019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY3549) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY3549) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY3549) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY3549) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-07-09 |