| NPI | 1194789180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS007825L) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS007825L) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS007825L) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2025-01-28 |