| NPI | 1336190966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS009409) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS009409) |
| 103TS0200X Psychologist, School (Licence: PA PS009409) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2013-07-02 |