| NPI | 1821312430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301015810) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MO 2008035687) |
| 103T00000X Psychologist (Licence: MO 2008035687) | |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301015810) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: MO 2008035687) | |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2022-09-30 |