| NPI | 1447322557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY6865) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY6865) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY6865) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2024-05-10 |