| NPI | 1053339291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS008553L) |
| 103TC1900X Psychologist, Counseling (Licence: PA PS008553L) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS008553L) | |
| 103TF0200X Psychologist, Forensic (Licence: PA PS008553L) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2018-04-12 |