NPI | 1245606920 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: DE B1-0001105) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 021232) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 35S100566000) | |
Enumeration Date | 2015-08-17 |
Last Update Date | 2017-11-29 |