| NPI | 1083714307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS 004983-L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS 004983-L) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2016-03-16 |