| NPI | 1215611702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301019308) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301019308) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2024-03-15 |