NPI | 1992776678 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO 797) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 797) |
103TF0200X Psychologist Forensic (Licence: CO 797) | |
103TR0400X Psychologist Rehabilitation (Licence: CO 797) | |
Enumeration Date | 2006-01-30 |
Last Update Date | 2007-07-23 |