| NPI | 1891850772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY 3794) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: FL PY 3794) |
| 103G00000X Clinical Neuropsychologist (Licence: FL PY3794) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2022-04-11 |