NPI | 1124096920 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 3482) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 3482) |
Enumeration Date | 2006-03-09 |
Last Update Date | 2014-09-08 |