| NPI | 1821661646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301018810) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301018810) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2024-02-21 |