NPI | 1568513992 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY0005130) |
Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY0005130) |
103TC0700X Psychologist, Clinical (Licence: FL PY0005130) | |
103TF0200X Psychologist, Forensic (Licence: FL PY0005130) | |
103TH0100X Psychologist, Health Service (Licence: FL PY0005130) | |
Enumeration Date | 2007-01-14 |
Last Update Date | 2022-08-26 |