NPI | 1558361857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810002048) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: DC PSY1000052) |
Enumeration Date | 2005-07-28 |
Last Update Date | 2008-08-12 |