NPI | 1447306782 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 4383) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 4383) |
Enumeration Date | 2007-01-27 |
Last Update Date | 2019-07-23 |