| NPI | 1710249362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.0004714) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: TX 36106) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO PSY.0004714) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 36106) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2021-09-10 |