| NPI | 1043360936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 2814) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MA 2814) |
| 103TC0700X Psychologist, Clinical (Licence: MA 2814) | |
| 103TF0000X Psychologist, Family (Licence: MA 2814) | |
| 103TH0100X Psychologist, Health Service (Licence: MA 2814) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MA 2814) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 2814) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-07-08 |