| NPI | 1205816907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS005445L) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS005445L) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2011-01-05 |