| NPI | 1881841708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP 5254) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301009538) |
| 103TC0700X Psychologist, Clinical (Licence: MN LP 5254) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MN LP 5254) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MN LP 5254) | |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301009538) | |
| 103G00000X Clinical Neuropsychologist (Licence: IL 071.005004) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.005004) | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2013-07-07 |