| NPI | 1174510176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY3985) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS4764 L) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS4764 L) | |
| 103TC0700X Psychologist, Clinical (Licence: FL PY3985) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2013-08-21 |