| NPI | 1750383006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY6497) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103T00000X Psychologist (Licence: FL PY6497) | |
| 104100000X Social Worker (Licence: FL SW4261) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2019-02-20 |