| NPI | 1982769212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY-10075) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY-10075) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY-10075) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2024-08-27 |