| NPI | 1467557025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS015043) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS015043) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2012-09-04 |