| NPI | 1154606283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS-006436-L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DE B1-0000561) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2017-05-10 |