| NPI | 1245363936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS002500L) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PA PS002500L) |
| 103T00000X Psychologist (Licence: PA PS002500L) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: PA PS002500L) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |