NPI | 1679754519 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: AZ 3934) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: AZ 3934) |
Enumeration Date | 2007-11-20 |
Last Update Date | 2024-05-01 |