| NPI | 1821093386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS005065L) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS-005065-L) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2015-08-19 |