| NPI | 1316511892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5994) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301018765) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2022-06-03 |