| NPI | 1588779722 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: GA PSY001032) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: GA PSY001032) |
| 103TC0700X Psychologist, Clinical (Licence: GA PSY001032) | |
| 103TF0000X Psychologist, Family (Licence: GA PSY001032) | |
| 103TF0200X Psychologist, Forensic (Licence: GA PSY001032) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2009-10-09 |