NPI | 1972742823 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301013173) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301013173) |
Enumeration Date | 2009-02-17 |
Last Update Date | 2011-04-12 |