| NPI | 1841275674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY7661) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CT 001601) |
| 103TC0700X Psychologist, Clinical (Licence: CT 001601) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2016-06-02 |