NPI | 1245212422 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS004670L) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS004670L) |
Enumeration Date | 2005-11-15 |
Last Update Date | 2015-02-20 |