| NPI | 1669454831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS015270) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS015270) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2018-10-09 |