| NPI | 1598749160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY001838) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY001838) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: GA PSY001838) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: GA PSY001838) | |
| 103TC0700X Psychologist, Clinical (Licence: GA PSY001838) | |
| 103TC1900X Psychologist, Counseling (Licence: GA PSY001838) | |
| 103TH0004X Psychologist, Health (Licence: GA PSY001838) | |
| 103TH0100X Psychologist, Health Service (Licence: GA PSY001838) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: GA PSY001838) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: GA PSY001838) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2007-09-06 |