| NPI | 1174784177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS018496) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY 8582) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2019-11-11 |