| NPI | 1497751291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP6399) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OK 800) |
| 103TC0700X Psychologist Clinical (Licence: OK 800) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: MN LP6399) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2020-12-10 |