NPI | 1063521326 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AZ 4848) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: GA 001130) |
103TC0700X Psychologist, Clinical (Licence: GA 1130) | |
Enumeration Date | 2006-08-30 |
Last Update Date | 2020-10-05 |