NPI | 1194761445 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS005938L) |
Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS005938L) |
103G00000X Clinical Neuropsychologist (Licence: PA PS005938L) | |
Enumeration Date | 2006-06-22 |
Last Update Date | 2016-07-25 |