| NPI | 1952610206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MO 2015016464) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OK 1257) |
| 103TC0700X Psychologist, Clinical (Licence: NM PSY1487) | |
| 103TC0700X Psychologist, Clinical (Licence: AR 15-04P) | |
| 103TC0700X Psychologist, Clinical (Licence: KS 2416) | |
| 103TC0700X Psychologist, Clinical (Licence: IA 086489) | |
| 103TS0200X Psychologist, School (Licence: TX 32763) | |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2024-09-24 |