| NPI | 1629116900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS016372) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NJ 4390) |
| 103T00000X Psychologist (Licence: NJ 4390) | |
| 103TC0700X Psychologist, Clinical (Licence: NJ 4390) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2021-08-25 |