| NPI | 1578604187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 3533) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AZ 3533) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 3533) | |
| 103TC0700X Psychologist, Clinical (Licence: AZ 3533) | |
| 103TH0100X Psychologist, Health Service (Licence: AZ 3533) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: AZ 3533) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2014-09-16 |