| NPI | 1124106398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301005488) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301005488) |
| 103G00000X Clinical Neuropsychologist (Licence: MI 6301005488) | |
| 103TF0200X Psychologist, Forensic (Licence: MI 6301005488) | |
| 103TH0004X Psychologist, Health (Licence: MI 6301005488) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: MI 6301005488) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2016-04-11 |