| NPI | 1982725834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2012007952) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY5039) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY5039) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: FL PY5039) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2023-11-06 |