| NPI | 1114926177 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS018034) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW014937) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2016-12-12 |