| NPI | 1629248059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY3543) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY3543) |
| 103TF0200X Psychologist, Forensic (Licence: FL PY3543) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2008-02-29 |