| NPI | 1598705675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301006879) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301006879) |
| 103T00000X Psychologist (Licence: MI 6301006879) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2023-10-18 |