NPI | 1801921333 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 001851) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CT 001851) |
Enumeration Date | 2007-02-23 |
Last Update Date | 2007-07-08 |