| NPI | 1447024617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301019342) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301019342) |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2024-05-14 |