| NPI | 1467448738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3083-57) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 00438) |
| 103T00000X Psychologist (Licence: IA 00438) | |
| 103TF0200X Psychologist, Forensic (Licence: IA 00438) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IA 00438) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2022-08-04 |