NPI | 1205900206 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 2772) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 04034) |
103G00000X Clinical Neuropsychologist (Licence: CA PSY13584) | |
103T00000X Psychologist (Licence: MD 04034) | |
103T00000X Psychologist (Licence: NC 2772) | |
103T00000X Psychologist (Licence: CA PSY13584) | |
Enumeration Date | 2006-11-20 |
Last Update Date | 2024-05-29 |