| NPI | 1285802660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301005403) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: MI 6301005403) |
| 103TC0700X Psychologist Clinical (Licence: MI 6301005403) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301005403) | |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2008-02-19 |