| NPI | 1336136308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS005117L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS005117-L) |
| 103TR0400X Psychologist, Rehabilitation (Licence: PA PS005117-L) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2007-07-08 |