| NPI | 1851638050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS018915) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2023-01-24 |