| NPI | 1619273810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS016934) |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2020-11-16 |