| NPI | 1811131840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: IA CPC0001) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 089968) |
| 103G00000X Clinical Neuropsychologist (Licence: NE 750) | |
| 103TC0700X Psychologist, Clinical (Licence: NE 750) | |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2023-04-28 |