| NPI | 1922091768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 4734) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY 4822) |
| 103TC0700X Psychologist, Clinical (Licence: OH 4734) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY 4822) | |
| 103TH0100X Psychologist, Health Service (Licence: FL PY 4822) | |
| 103TH0100X Psychologist, Health Service (Licence: OH 4734) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2014-05-09 |