| NPI | 1083705917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IA 356) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00842) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IA 00842) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IA 00842) | |
| 103T00000X Psychologist (Licence: CO 0006871) | |
| 103TC0700X Psychologist, Clinical (Licence: IA 00842) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IA 00842) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2025-11-20 |