| NPI | 1316978935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: LA 541) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: LA 541) |
| 103TC0700X Psychologist, Clinical (Licence: LA 541) | |
| 103TF0200X Psychologist, Forensic (Licence: LA 541) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: LA 541) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2007-07-08 |