| NPI | 1336337013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 3470) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ 3405) |
| 103T00000X Psychologist (Licence: AZ 3405) | |
| 103TC0700X Psychologist, Clinical (Licence: AZ 3405) | |
| 103TC1900X Psychologist, Counseling (Licence: AZ 3405) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ 3405) | |
| 103TF0000X Psychologist, Family (Licence: AZ 3405) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ 3470) | |
| 103G00000X Clinical Neuropsychologist (Licence: AZ 071.005473) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ 071.005473) | |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2009-09-02 |