| NPI | 1710201611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA MP.000041) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 34475) |
| 103TC0700X Psychologist, Clinical (Licence: TX 34475) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: TX 34475) | |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2022-04-29 |