| NPI | 1174927172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 4543) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ 4543) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 4543) | |
| 103TC0700X Psychologist, Clinical (Licence: AZ 4543) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ 4543) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: AZ 4543) | |
| 103TH0004X Psychologist, Health (Licence: AZ 4543) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AZ 4543) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: AZ 4543) | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2014-10-20 |