| NPI | 1194761445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS005938L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS005938L) |
| 103G00000X Clinical Neuropsychologist (Licence: PA PS005938L) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2016-07-25 |