| NPI | 1710935515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TR0400X Psychologist, Rehabilitation (Licence: AZ 1627) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: AZ 1627) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ 1627) | |
| 103T00000X Psychologist (Licence: AZ 1627) | |
| 103G00000X Clinical Neuropsychologist (Licence: AZ 1627) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2013-04-12 |