| NPI | 1245485861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS016548) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS16548) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2023-01-31 |