| NPI | 1194704031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: GA PSY000724) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: GA PSY000724) |
| 103TC1900X Psychologist, Counseling (Licence: GA PSY000724) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: GA PSY000724) | |
| 103TF0200X Psychologist, Forensic (Licence: GA PSY000724) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: GA PSY000724) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2007-07-09 |