NPI | 1962528133 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 2159) |
Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MD 2159) |
103TR0400X Psychologist, Rehabilitation (Licence: MD 2159) | |
Enumeration Date | 2007-03-21 |
Last Update Date | 2007-07-08 |