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 |