| NPI | 1801978473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP4638) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP4638) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2015-06-25 |