NPI | 1255904819 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY11054) |
Enumeration Date | 2021-07-21 |
Last Update Date | 2021-07-21 |