| NPI | 1831309814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301013048) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301013048) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2019-11-12 |