| NPI | 1073593620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP3855) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 2179-057) |
| 103G00000X Clinical Neuropsychologist (Licence: MN LP3855) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2026-07-04 |