| NPI | 1558328740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY3919) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY003919) |
| 103T00000X Psychologist (Licence: FL PY3919) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2010-09-10 |