| NPI | 1013093996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS015387) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: PA PS015387) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2018-08-29 |