| NPI | 1386667905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS-006545-L) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NJ SI 03245) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS-006545-L) | |
| 103TC0700X Psychologist, Clinical (Licence: NJ SI 03245) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2014-09-08 |