| NPI | 1194949495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: FL PY8016) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH9083) |
| 103G00000X Clinical Neuropsychologist (Licence: FL PY8016) | |
| 103T00000X Psychologist (Licence: FL PY8016) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY8016) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY8016) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2018-03-17 |