| NPI | 1972742823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MI 6301013173) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301013173) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2011-04-12 |