| NPI | 1225138720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AL 283) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: AL 283) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: AL 283) | |
| 103TC0700X Psychologist Clinical (Licence: AL 283) | |
| 103TC1900X Psychologist Counseling (Licence: AL 283) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: AL 283) | |
| 103T00000X Psychologist (Licence: AL 283) | |
| 103TF0000X Psychologist Family (Licence: AL 283) | |
| 103TH0100X Psychologist Health Service (Licence: AL 283) | |
| 103TR0400X Psychologist Rehabilitation (Licence: AL 283) | |
| 103TS0200X Psychologist School (Licence: AL 283) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2007-07-08 |