| NPI | 1306834551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301007332) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301007332) |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301007332) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2023-05-21 |