| NPI | 1700827334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL 7850) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: FL 7850) |
| 103TC0700X Psychologist, Clinical (Licence: FL 7850) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2010-09-10 |