Individual
Inactive
Sole proprietor
Provider details
NPI number
Contact information
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
Primary
—
—
103TF0200X
Forensic Psychologist
—
—
Other
Enumeration date
—
Last updated
—
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