| NPI | 1760556245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MN LP4899) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MN LP4899) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2024-08-16 |