| NPI | 1376681957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS005101L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS005101L) |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2016-02-02 |