| NPI | 1194777037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY7414) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 5478) |
| 103TC0700X Psychologist, Clinical (Licence: OH 5478) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 5478) | |
| 103TF0200X Psychologist, Forensic (Licence: OH 5478) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: OH 5478) | |
| 103T00000X Psychologist (Licence: OH 5478) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY7414) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY7414) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY7414) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: FL PY7414) | |
| 103T00000X Psychologist (Licence: FL PY7414) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-04-12 |