| NPI | 1568426765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS003428L) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS003428L) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS003428L) | |
| 103TC1900X Psychologist, Counseling (Licence: PA PS003428L) | |
| 103T00000X Psychologist (Licence: PA PS003428L) | |
| 103TS0200X Psychologist, School (Licence: PA PS003428L) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2007-07-08 |