| NPI | 1942292354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301003315) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301003315) |
| 103TC0700X Psychologist Clinical (Licence: MI 680F328500) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2020-10-20 |