| NPI | 1669104378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 7111) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PR 7111) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PR 7111) | |
| 103G00000X Clinical Neuropsychologist (Licence: PR 7111) | |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2023-11-24 |