| 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 |