| NPI | 1356424972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO PYR0452) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MO PYR0452) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MO PYR0452) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MO PYR0452) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: MO PYR0452) | |
| 103TC0700X Psychologist, Clinical (Licence: MO R0452) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2020-04-29 |