NPI | 1407844277 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IA 00929) |
Additional Taxonomies | 103T00000X Psychologist (Licence: IA 00424) |
103T00000X Psychologist (Licence: IA 00929) | |
103T00000X Psychologist (Licence: MN LP1079) | |
103T00000X Psychologist (Licence: IL 071006441) | |
Enumeration Date | 2005-10-06 |
Last Update Date | 2007-07-09 |