| NPI | 1194906990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016089) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: GA 003131) |
| 103G00000X Clinical Neuropsychologist (Licence: MI 6301016089) | |
| 103TC0700X Psychologist, Clinical (Licence: GA 003131) | |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2019-11-25 |