| NPI | 1962545517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: NM 1051) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: NM 1051) |
| 103G00000X Clinical Neuropsychologist (Licence: NM 1051) | |
| 103G00000X Clinical Neuropsychologist (Licence: CA 15463) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2010-10-04 |