| NPI | 1619379161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301002143) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301002143) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2014-09-16 |