| NPI | 1902906209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: UT 5525037-2501) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: ID PSY-202491) |
| 103T00000X Psychologist (Licence: UT 5525037-2501) | |
| 103T00000X Psychologist (Licence: ID PSY-202491) | |
| 103TC0700X Psychologist, Clinical (Licence: UT 5525037-2501) | |
| 103TC0700X Psychologist, Clinical (Licence: ID PSY-202491) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: UT 5525037-2501) | |
| 103TF0000X Psychologist, Family (Licence: ID PSY-202491) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2009-08-20 |