NPI | 1396203956 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY11209) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY11209) |
Enumeration Date | 2019-03-03 |
Last Update Date | 2022-12-13 |