| NPI | 1750427969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY6162) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY6162) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: FL PY6162) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2014-05-19 |