| NPI | 1801206115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 4495) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: AZ 4495) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: AZ 4495) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: AZ 4495) | |
| 103TC0700X Psychologist Clinical (Licence: AZ 4495) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: AZ 4495) | |
| 103TF0000X Psychologist Family (Licence: AZ 4495) | |
| 103TF0200X Psychologist Forensic (Licence: AZ 4495) | |
| 103TH0004X Psychologist Health (Licence: AZ 4495) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: AZ 4495) | |
| 103TR0400X Psychologist Rehabilitation (Licence: AZ 4495) | |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2014-05-08 |