NPI | 1831689710 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TR0400X Psychologist, Rehabilitation (Licence: WA PY60866264) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60866264) |
103G00000X Clinical Neuropsychologist (Licence: MI 6301017125) | |
103T00000X Psychologist (Licence: WA PY60866264) | |
Enumeration Date | 2018-05-16 |
Last Update Date | 2021-08-20 |