| NPI | 1245313543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: KY 581) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: KY 581) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: KY 581) | |
| 103TC0700X Psychologist Clinical (Licence: KY 581) | |
| 103T00000X Psychologist (Licence: KY 581) | |
| 103TF0200X Psychologist Forensic (Licence: KY 581) | |
| 103TH0100X Psychologist Health Service (Licence: KY 581) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: KY 581) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-08 |