| NPI | 1912043860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: OK 754) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OK 754) |
| 103G00000X Clinical Neuropsychologist (Licence: HI 579) | |
| 103TC0700X Psychologist Clinical (Licence: OK 754) | |
| 103TC0700X Psychologist Clinical (Licence: HI 579) | |
| 103TH0100X Psychologist Health Service (Licence: HI 579) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2010-07-15 |