| NPI | 1417014069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY4064) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY4064) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: FL PY4064) | |
| 103TC0700X Psychologist Clinical (Licence: FL PY4064) | |
| 103TF0200X Psychologist Forensic (Licence: FL PY4064) | |
| 103TR0400X Psychologist Rehabilitation (Licence: FL PY4064) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2008-09-13 |