| NPI | 1225302581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS017178) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS017178) |
| 103TC1900X Psychologist, Counseling (Licence: PA PS017178) | |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2021-04-23 |