NPI | 1770572935 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AR 92-17P) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AR 92-17P) |
Enumeration Date | 2005-10-19 |
Last Update Date | 2007-07-08 |