| NPI | 1356417596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY9043) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY9043) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY9043) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY9043) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: FL PY9043) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY9043) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: FL PY9043) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2015-09-23 |