| NPI | 1225038904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301007792) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301007792) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2007-07-08 |