| NPI | 1629226998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 096771) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 001106) |
| 103G00000X Clinical Neuropsychologist (Licence: NE 1043) | |
| 103G00000X Clinical Neuropsychologist (Licence: IA 096771) | |
| 104100000X Social Worker (Licence: IA 02891) | |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2022-10-10 |