| NPI | 1609086453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: MD 2019) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 2019) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MD 2019) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 2019) | |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: MD 2019) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2025-09-11 |