| NPI | 1790857217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301005829) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301005829) |
| 103T00000X Psychologist (Licence: MI 6301005829) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: MI 6301005829) | |
| 103TH0004X Psychologist, Health (Licence: MI 6301005829) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2021-04-27 |