NPI | 1538113329 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS015165) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 2031-057) |
Enumeration Date | 2006-05-19 |
Last Update Date | 2007-07-08 |