| NPI | 1265685853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY003327) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: GA 003327) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2025-03-20 |