| NPI | 1811452238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA TPS030775) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WV 1217) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA TPS030775) | |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2023-04-06 |