| NPI | 1972649689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: ME PS921) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 1718) |
| 103G00000X Clinical Neuropsychologist (Licence: NH 310) | |
| 103TC0700X Psychologist, Clinical (Licence: ME PS921) | |
| 103TC0700X Psychologist, Clinical (Licence: MA 1718) | |
| 103TC0700X Psychologist, Clinical (Licence: NH 310) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: ME PS921) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MA 1718) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NH 310) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2010-12-22 |