| NPI | 1083669899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: GA PSY002944) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: GA PSY002944) |
| 103TR0400X Psychologist Rehabilitation (Licence: GA PSY002944) | |
| 103T00000X Psychologist (Licence: GA PSY002944) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2007-07-08 |