| NPI | 1992913198 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS-004175-L) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS004175-L) |
| 103T00000X Psychologist (Licence: NJ 1838) | |
| 103T00000X Psychologist (Licence: NY 010299) | |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2010-11-29 |