| NPI | 1568544252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS004015L) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NJ 35S100201000) |
| 103G00000X Clinical Neuropsychologist (Licence: NY 0124601) | |
| 103T00000X Psychologist (Licence: PA PS004015L) | |
| 103T00000X Psychologist (Licence: NJ 35S100201000) | |
| 103T00000X Psychologist (Licence: NY 0124601) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2007-07-08 |