| NPI | 1093847584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: PA PS005818L) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS005818L) |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2014-11-03 |