| NPI | 1649782244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301016806) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2017-11-04 |
| Last Update Date | 2017-11-04 |