NPI | 1780118687 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 5022) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 5022) |
Enumeration Date | 2017-04-18 |
Last Update Date | 2017-04-18 |