| NPI | 1447218243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS005717L) |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology (Licence: PA PS005717L) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2017-01-13 |