| NPI | 1760560643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS002303L) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS002303L) |
| 103TF0200X Psychologist Forensic (Licence: PA PA002303L) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |