| NPI | 1790748366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 1775) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NC 1775) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NC 1775) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NC 1775) | |
| 103TC0700X Psychologist, Clinical (Licence: NC 1775) | |
| 103TH0100X Psychologist, Health Service (Licence: NC 1775) | |
| 103T00000X Psychologist (Licence: NC 1775) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NC 1775) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2007-07-08 |