| NPI | 1457537565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 3635) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103T00000X Psychologist (Licence: PR 3635) | |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2023-09-18 |