| NPI | 1427285105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301013625) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301013625) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2009-06-19 |