| NPI | 1427234491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 1488) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 1488) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CT 1488) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: CT 1488) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CT 1488) | |
| 103TC0700X Psychologist Clinical (Licence: CT 1488) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CT 1488) | |
| 103TF0000X Psychologist Family (Licence: CT 1488) | |
| 103TF0200X Psychologist Forensic (Licence: CT 1488) | |
| 103TH0004X Psychologist Health (Licence: CT 1488) | |
| 103TH0100X Psychologist Health Service (Licence: CT 1488) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: CT 1488) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CT 1488) | |
| 103TR0400X Psychologist Rehabilitation (Licence: CT 1488) | |
| 103TS0200X Psychologist School (Licence: CT 1488) | |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2019-03-22 |