| NPI | 1528147360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301012443) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MI 6301012443) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301012443) | |
| 103TF0000X Psychologist Family (Licence: MI 6301012443) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: MI 6301012443) | |
| 103TR0400X Psychologist Rehabilitation (Licence: MI 6301012443) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2007-07-08 |