NPI | 1093778573 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 02725) |
Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: MD 02725) |
Enumeration Date | 2006-04-07 |
Last Update Date | 2007-07-10 |