| NPI | 1548312549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: SC 880) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 880) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: SC 880) | |
| 103TC0700X Psychologist Clinical (Licence: SC 880) | |
| 103TH0100X Psychologist Health Service (Licence: SC 880) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: SC 880) | |
| 103TR0400X Psychologist Rehabilitation (Licence: SC 880) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2016-04-29 |