NPI | 1104170935 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: HI 1353) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI 1353) |
Enumeration Date | 2012-10-31 |
Last Update Date | 2014-11-04 |