| NPI | 1164509030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017908) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA cw014990) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2021-09-10 |