| NPI | 1770637431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP4765) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 21047) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2021-03-09 |