| NPI | 1992906747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 3745) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1117) |
| 103TC0700X Psychologist, Clinical (Licence: WA PY00003898) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 32594) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2011-05-19 |