| NPI | 1033314018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016055) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103T00000X Psychologist (Licence: PA PS016055) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS016055) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2025-04-28 |