NPI | 1629116470 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: TX 30829) |
Additional Taxonomies | 103T00000X Psychologist (Licence: TX 30829) |
Enumeration Date | 2007-02-02 |
Last Update Date | 2008-01-30 |