| NPI | 1952700403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6801092812) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MI 6301016035) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-09-11 |