| NPI | 1447206941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: WV 514) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WV 514) |
| 103TC0700X Psychologist, Clinical (Licence: WV 514) | |
| 103TF0200X Psychologist, Forensic (Licence: WV 514) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2023-08-17 |