| NPI | 1164461992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS004527L) |
| Additional Taxonomies | 103TF0000X Psychologist, Family |
| 103T00000X Psychologist | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2012-03-01 |