| NPI | 1417255175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS006988L) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS006988L) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS006988L) | |
| 103TF0200X Psychologist, Forensic (Licence: PA PS006988L) | |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2011-03-04 |