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 |