| NPI | 1386721702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301008990) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301008990) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-04-10 |