| NPI | 1134519523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS018515) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC005164) |
| Enumeration Date | 2015-01-23 |
| Last Update Date | 2021-11-22 |