| NPI | 1922168244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP3921) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CO 1929) |
| 103TC0700X Psychologist Clinical (Licence: MN LP3921) | |
| 103TC0700X Psychologist Clinical (Licence: CO 1929) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2020-12-30 |