| NPI | 1831217298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: AZ 1169) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ 1169) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: AZ 1169) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: AZ 1169) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: AZ 1169) | |
| 103TC1900X Psychologist, Counseling (Licence: AZ 1169) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: AZ 1169) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: AZ 1169) | |
| 103TF0000X Psychologist, Family (Licence: AZ 1169) | |
| 103TF0200X Psychologist, Forensic (Licence: AZ 1169) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: AZ 1169) | |
| 103T00000X Psychologist (Licence: AZ 1169) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: AZ 1169) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2025-09-11 |