NPI | 1992711857 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MD 02813) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: DC PSY1660) |
Enumeration Date | 2006-07-31 |
Last Update Date | 2007-07-08 |