| NPI | 1134328420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: KS 794) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MO PYRO327) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: KS 794) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MO PYRO327) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KS 794) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MO PYRO327) | |
| 103TC0700X Psychologist, Clinical (Licence: KS 794) | |
| 103TC0700X Psychologist, Clinical (Licence: MO PYRO327) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: KS 794) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO PYRO327) | |
| 103TF0200X Psychologist, Forensic (Licence: KS 794) | |
| 103TF0200X Psychologist, Forensic (Licence: MO PYRO327) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2007-07-16 |