| NPI | 1275876963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301016060) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301014783) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301014783) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2018-08-09 |