| NPI | 1558693390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AR 97-15P) |
| 103G00000X Clinical Neuropsychologist (Licence: AR 97-15P) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AR 97-15P) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AR 97-15P) | |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2012-10-02 |