| NPI | 1093028961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS015045) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS015045) |
| 103G00000X Clinical Neuropsychologist (Licence: DE B1-0000722) | |
| 103TC0700X Psychologist Clinical (Licence: DE B1-0000722) | |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2010-07-21 |