NPI | 1205142304 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 35SI00562000) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810004484) |
103G00000X Clinical Neuropsychologist (Licence: PA PS018103) | |
Enumeration Date | 2010-08-26 |
Last Update Date | 2019-02-07 |