| NPI | 1811982598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY4238) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY4238) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY4238) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY4238) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY4238) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY4238) | |
| 103TH0100X Psychologist, Health Service (Licence: FL PY4238) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: FL PY4238) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: FL PY4238) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2022-07-21 |