NPI | 1316950678 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301007688) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301007688) |
Enumeration Date | 2006-08-15 |
Last Update Date | 2015-01-27 |