| NPI | 1083958813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AL 1792) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AL 1792) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AL 1792) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AL 1792) | |
| 103TH0004X Psychologist, Health (Licence: AL 1792) | |
| 103TH0100X Psychologist, Health Service (Licence: AL 1792) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AL 1792) | |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2018-03-17 |