| NPI | 1558476861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: FL PY5032) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY5032) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: FL PY5032) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY5032) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2025-09-11 |