| NPI | 1215989967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: SC 792) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: SC 792) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: SC 792) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: SC 792) | |
| 103TF0000X Psychologist, Family (Licence: SC 792) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2017-03-24 |