NPI | 1114011558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO 1212) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO 1212) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2008-08-18 |