| NPI | 1346459625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY4681) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY4681) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY4681) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: FL PY4681) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY4681) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY4681) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY4681) | |
| 103TF0000X Psychologist, Family (Licence: FL PY4681) | |
| 103TF0200X Psychologist, Forensic (Licence: FL PY4681) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: FL PY4681) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |