| NPI | 1992173884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PA PS005335L) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS005335L) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PA PS005335L) | |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |