| NPI | 1336621622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS019130) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2018-09-03 |
| Last Update Date | 2025-08-06 |