| 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 |