| NPI | 1376692889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ SI 03735) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS-005007-L) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2014-05-19 |