| NPI | 1326395039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN 6635) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 9563) |
| 103TC0700X Psychologist, Clinical (Licence: MA 9563) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 9563) | |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2020-12-31 |