| NPI | 1922123645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AR 202170) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: SC 1382) |
| 103G00000X Clinical Neuropsychologist (Licence: MI 6301010098) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2022-07-28 |