| NPI | 1841371291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: DC PSY1773) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 03064) |
| 103T00000X Psychologist (Licence: DC PSY1773) | |
| 103T00000X Psychologist (Licence: MD 03064) | |
| 103TC0700X Psychologist Clinical (Licence: DC PSY1773) | |
| 103TC0700X Psychologist Clinical (Licence: MD 03064) | |
| 103TF0200X Psychologist Forensic (Licence: DC PSY1773) | |
| 103TF0200X Psychologist Forensic (Licence: MD 03064) | |
| 103TH0100X Psychologist Health Service (Licence: DC PSY1773) | |
| 103TH0100X Psychologist Health Service (Licence: MD 03064) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: DC PSY1773) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: MD 03064) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: DC PSY1773) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: MD 03064) | |
| 103TR0400X Psychologist Rehabilitation (Licence: DC PSY1773) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2018-12-07 |