NPI | 1083912794 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0003758) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO PSY3758) |
103TC0700X Psychologist, Clinical (Licence: WA PY60060442) | |
Enumeration Date | 2011-03-03 |
Last Update Date | 2016-05-13 |