| NPI | 1548325087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 2951) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 2951) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NC 2951) | |
| 103TF0200X Psychologist Forensic (Licence: NC 2951) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-09 |