| NPI | 1629157185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301007285) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| 103T00000X Psychologist (Licence: MI 6301007285) | |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2007-07-08 |