| NPI | 1003913757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS-006401-L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS006401) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2024-11-14 |