NPI | 1023179538 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0024) |
Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MPAP000019) |
103G00000X Clinical Neuropsychologist (Licence: NM 1232) | |
Enumeration Date | 2006-12-12 |
Last Update Date | 2015-06-09 |