NPI | 1073531463 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY7815) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OH 5956) |
103T00000X Psychologist (Licence: FL PY7815) | |
Enumeration Date | 2006-07-17 |
Last Update Date | 2021-03-19 |