| NPI | 1902964927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NH 171) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NH 171) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NH 171) | |
| 103TH0100X Psychologist Health Service (Licence: NH 171) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NH 171) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NH 171) | |
| 103TR0400X Psychologist Rehabilitation (Licence: NH 171) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |