| NPI | 1235508896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WV 686) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS017871) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2015-09-24 |