NPI | 1265644637 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 2249) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 2249) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NC 2249) | |
103TF0200X Psychologist, Forensic (Licence: NC 2249) | |
103TR0400X Psychologist, Rehabilitation (Licence: NC 2249) | |
Enumeration Date | 2007-05-05 |
Last Update Date | 2018-05-26 |