| NPI | 1598205395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 003129) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CT 3129) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CT 003129) | |
| 103TF0000X Psychologist, Family (Licence: CT 003129) | |
| 103TF0200X Psychologist, Forensic (Licence: CT 003129) | |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2022-07-29 |