NPI | 1568661981 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS017596) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS017596) |
Enumeration Date | 2007-07-16 |
Last Update Date | 2023-06-26 |