| NPI | 1104986454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS 005215 L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DE B10000503) |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2007-07-09 |