| NPI | 1396151049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY10607) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: KS LP 2203) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY10607) | |
| 103TC0700X Psychologist, Clinical (Licence: KS LP2203) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2022-02-03 |