| NPI | 1578128211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS018771) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810005966) | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2019-10-07 |