| NPI | 1043234859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 630100750) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 630100750) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2011-10-21 |