| NPI | 1013242148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PC002229) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PC002229) |
| 103TC1900X Psychologist, Counseling (Licence: PA PC002229) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PC002229) | |
| 103TF0000X Psychologist, Family (Licence: PA MF000231) | |
| 103TH0004X Psychologist, Health (Licence: PA PC002229) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: PA PC002229) | |
| 103TS0200X Psychologist, School (Licence: PA PC002229) | |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2009-10-07 |