| NPI | 1952549891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301007077) | |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2009-01-30 |