| NPI | 1104004787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 2614-057) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: WI 2614-057) |
| 103TH0100X Psychologist, Health Service (Licence: WI 2614-057) | |
| 103G00000X Clinical Neuropsychologist (Licence: WI 2614-057) | |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2026-08-05 |