| NPI | 1912041492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP1585) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MN LP1585) |
| 103TC0700X Psychologist Clinical (Licence: MN LP1585) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2014-12-22 |