| NPI | 1225033384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS002387L) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PA PS002387L) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS002387L) | |
| 103TF0000X Psychologist, Family (Licence: PA PS002387L) | |
| 103TF0200X Psychologist, Forensic (Licence: PA PS002387L) | |
| 103TP0814X Psychologist, Psychoanalysis (Licence: PA PS002387L) | |
| 103T00000X Psychologist (Licence: PA PS002387L) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: PA PS002387L) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2009-03-24 |