NPI | 1831119551 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY2600) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL PY2600) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: FL PY2600) | |
103TF0200X Psychologist, Forensic (Licence: FL PY2600) | |
106H00000X Marriage & Family Therapist (Licence: FL MF519) | |
Enumeration Date | 2006-07-19 |
Last Update Date | 2012-02-06 |