| NPI | 1114072220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 2081) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 2081) |
| 103T00000X Psychologist (Licence: AZ 2081) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: AZ 2081) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 2081) | |
| 103TF0200X Psychologist, Forensic (Licence: AZ 2081) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: AZ 2081) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2025-08-30 |