NPI | 1578050084 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.0004779) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY.0004779) |
103TR0400X Psychologist, Rehabilitation (Licence: CO PSY.0004779) | |
Enumeration Date | 2018-04-19 |
Last Update Date | 2021-06-21 |