| NPI | 1619225489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301017839) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA 33059) |
| 103G00000X Clinical Neuropsychologist (Licence: MI 6301017839) | |
| 103T00000X Psychologist (Licence: MI 6301017839) | |
| 103T00000X Psychologist (Licence: CA 33059) | |
| 103TC0700X Psychologist Clinical (Licence: CA 33059) | |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2022-10-09 |