NPI | 1023197431 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 05505) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI 840) |
103G00000X Clinical Neuropsychologist (Licence: HI 840) | |
Enumeration Date | 2006-11-04 |
Last Update Date | 2025-09-04 |