| NPI | 1043239668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS-002053-L) |
| Additional Taxonomies | 103TS0200X Psychologist School |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2008-01-08 |