| NPI | 1033512736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS017696) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS017696) |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: PA PS017696) | |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2022-07-21 |