NPI | 1760597223 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY29699) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 015577) |
103TC0700X Psychologist, Clinical (Licence: NY 015577) | |
Enumeration Date | 2006-08-21 |
Last Update Date | 2023-03-14 |