| NPI | 1225824899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP7123) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN LP7123) |
| Enumeration Date | 2025-04-18 |
| Last Update Date | 2025-09-04 |