| NPI | 1871560326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301005658) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301005658) |
| 103T00000X Psychologist (Licence: MI 6301005658) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2019-02-25 |