NPI | 1063579183 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 7092) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 7092) |
Enumeration Date | 2007-01-02 |
Last Update Date | 2019-03-11 |