| NPI | 1689991119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY 8083) |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: FL PY8083) | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2020-03-27 |