| NPI | 1407847338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TR0400X Psychologist Rehabilitation (Licence: MN 5080) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN 5080) |
| 103TC0700X Psychologist Clinical (Licence: MN 5080) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2013-09-18 |