NPI | 1679516645 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 002567) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 015711-1) |
Enumeration Date | 2006-06-14 |
Last Update Date | 2013-02-28 |