NPI | 1487830402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS 006496L) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301011261) |
Enumeration Date | 2008-01-22 |
Last Update Date | 2008-06-02 |