| NPI | 1992794093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 728MP) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: LA 728MP) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2022-05-26 |