| NPI | 1134102817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS-004781-L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS004781-L) |
| Enumeration Date | 2005-11-27 |
| Last Update Date | 2009-08-06 |