| NPI | 1033208319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 1227-057) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 1227-057) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: WI 1227-057) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2012-01-20 |