| NPI | 1821139098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist Adult Development & Aging (Licence: NV PY0118) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NV PY0118) |
| 103TC0700X Psychologist Clinical (Licence: NV PY0118) | |
| 103TH0100X Psychologist Health Service (Licence: NV PY0118) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NV PY0118) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-12-26 |