| NPI | 1568473569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP0311) |
| Additional Taxonomies | 103TH0004X Psychologist Health (Licence: MN LP0311) |
| 103TC0700X Psychologist Clinical (Licence: MN LP0311) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-11-15 |