| NPI | 1235115171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301011637) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 63010111637) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301011637) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2008-01-03 |