| NPI | 1598204869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP4248) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN LP4248) |
| Enumeration Date | 2017-02-19 |
| Last Update Date | 2018-03-15 |