| NPI | 1669497111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO 2962) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WY 478) |
| 103TC0700X Psychologist, Clinical (Licence: CA psy18408) | |
| 103TC0700X Psychologist, Clinical (Licence: WY 478) | |
| 103TC0700X Psychologist, Clinical (Licence: CO 2962) | |
| 103TF0200X Psychologist, Forensic (Licence: CO 2962) | |
| 103TH0004X Psychologist, Health (Licence: CO 2962) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2018-04-07 |