NPI | 1902863616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 6635) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 6635) |
103TR0400X Psychologist, Rehabilitation (Licence: MA 6635) | |
Enumeration Date | 2006-04-27 |
Last Update Date | 2007-07-08 |