| NPI | 1346280971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP6425) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN LP6425) |
| 103T00000X Psychologist (Licence: IA 073858) | |
| 103T00000X Psychologist (Licence: WA 2492) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2021-03-24 |