NPI | 1124008511 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 35SI00271600) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NJ SI00271600) |
Enumeration Date | 2006-01-20 |
Last Update Date | 2024-03-14 |