| NPI | 1982822581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 2487) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CO 2487) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CO 2487) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CO 2487) | |
| 103G00000X Clinical Neuropsychologist (Licence: CO 2487) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 2487) | |
| 103TF0000X Psychologist, Family (Licence: CO 2487) | |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2019-10-01 |