NPI | 1295872158 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS006907L) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS006907L) |
Enumeration Date | 2007-01-31 |
Last Update Date | 2012-12-23 |