| NPI | 1578875407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS016992) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2011-11-27 |