NPI | 1760430672 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IA 00514) |
Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: IA 00514) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: IA 00514) | |
103TC1900X Psychologist, Counseling (Licence: IA 00514) | |
103TH0100X Psychologist, Health Service (Licence: IA 00514) | |
103T00000X Psychologist (Licence: IA 00514) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: IA 00514) | |
103TR0400X Psychologist, Rehabilitation (Licence: IA 00514) | |
Enumeration Date | 2006-05-04 |
Last Update Date | 2007-07-08 |