| NPI | 1689690307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY4068) |
| Additional Taxonomies | 103TR0400X Psychologist Rehabilitation (Licence: FL PY4068) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-07-12 |