| NPI | 1154381325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS-005358-L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1060) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2013-10-18 |