| NPI | 1427234707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301013374) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301013374) |
| 103TR0400X Psychologist, Rehabilitation (Licence: MI 6301013374) | |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2023-11-28 |