| NPI | 1922263276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 003257) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103T00000X Psychologist | |
| 103T00000X Psychologist (Licence: NY 019804) | |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY 25861) | |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2013-08-03 |