NPI | 1962734194 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810004180) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004180) |
Enumeration Date | 2010-02-15 |
Last Update Date | 2010-02-15 |