| NPI | 1205142304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 35SI00562000) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810004484) |
| 103G00000X Clinical Neuropsychologist (Licence: PA PS018103) | |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2019-02-07 |