| NPI | 1215004668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 129) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 0003) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2018-08-28 |