| NPI | 1750436374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY3577) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY3577) |
| 103TF0200X Psychologist Forensic (Licence: FL PY3577) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-07-08 |