| NPI | 1770141673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP6782) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301017201) |
| 103TC0700X Psychologist Clinical (Licence: MN LP6782) | |
| 103TC0700X Psychologist Clinical (Licence: MI 6301017201) | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2022-06-10 |