| NPI | 1437378890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY00002068) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY00002068) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY00002068) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY00002068) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY00002068) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |