| NPI | 1265623011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04989) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 04989) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 04989) | |
| 103TC0700X Psychologist, Clinical (Licence: MD 04989) | |
| 103TF0200X Psychologist, Forensic (Licence: MD 04989) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MD 04989) | |
| 103TP0814X Psychologist, Psychoanalysis (Licence: MD 04989) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2019-08-24 |