| NPI | 1265433361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: PA MD045133E) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA MD045133E) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2018-11-19 |