NPI | 1497751291 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP6399) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OK 800) |
103TC0700X Psychologist Clinical (Licence: OK 800) | |
2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN LP6399) | |
Enumeration Date | 2005-06-27 |
Last Update Date | 2020-12-10 |