| NPI | 1548817935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301017322) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 3703) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2026-10-16 |