NPI | 1720024607 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY001660) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: KY KY-0862) |
103G00000X Clinical Neuropsychologist (Licence: IN 20040782A) | |
103T00000X Psychologist (Licence: GA PSY1660) | |
103T00000X Psychologist (Licence: KY KY-0862) | |
103T00000X Psychologist (Licence: IN 20040782A) | |
103TF0200X Psychologist, Forensic (Licence: GA PSY001660) | |
Enumeration Date | 2006-06-21 |
Last Update Date | 2007-07-08 |