| NPI | 1548577034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY 8127) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY 8127) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2013-04-02 |