| NPI | 1316039357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301006050) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301 006050) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2018-03-17 |