NPI | 1568418812 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP4692) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN LP 4692) |
103T00000X Psychologist (Licence: MN LP 4692) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP 4692) | |
2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: MN LP 4692) | |
Enumeration Date | 2006-05-26 |
Last Update Date | 2007-07-08 |