| NPI | 1124192281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS005925L) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: DE B1-0000865) |
| 103TC0700X Psychologist Clinical (Licence: FL PY8532) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2019-04-24 |