| NPI | 1568418812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP4692) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN LP 4692) |
| 103T00000X Psychologist (Licence: MN LP 4692) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MN LP 4692) | |
| 2084P0005X Psychiatry & Neurology Neurodevelopmental Disabilities (Licence: MN LP 4692) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2007-07-08 |