| NPI | 1356460901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OR 1307) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OR 1307) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: OR 1307) | |
| 103TF0200X Psychologist Forensic (Licence: OR 1307) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: OR 1307) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |