| NPI | 1780801514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301013684) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC1900X Psychologist, Counseling | |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2021-03-26 |