NPI | 1134244403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 0693) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 005165-1) |
103TC0700X Psychologist, Clinical (Licence: CT 0693) | |
103TC0700X Psychologist, Clinical (Licence: NY 005165-1) | |
Enumeration Date | 2007-03-19 |
Last Update Date | 2007-07-08 |