| NPI | 1194858639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS005598L) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NJ 35SI00357900) |
| 103G00000X Clinical Neuropsychologist (Licence: PA PS005598L) | |
| 103T00000X Psychologist (Licence: NJ 35SI00357900) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2020-11-09 |