| NPI | 1053414995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY000925) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA PSY000925) |
| 103T00000X Psychologist (Licence: GA PSY000925) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: GA PSY000925) | |
| 103TS0200X Psychologist, School (Licence: GA PSY000925) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2011-03-31 |