NPI | 1962414631 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 1295) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NC 1295) |
Enumeration Date | 2006-08-12 |
Last Update Date | 2007-07-08 |