| NPI | 1851376578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 3637) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NH 353) |
| 103G00000X Clinical Neuropsychologist (Licence: MA 3637) | |
| 103TC0700X Psychologist, Clinical (Licence: MA 3637) | |
| 103TF0200X Psychologist, Forensic (Licence: MA 3637) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2007-07-08 |