| NPI | 1235465733 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY003268) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY003268) |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2022-01-10 |