| NPI | 1275679540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: PA PS-006990-L) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS-006990-L) |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: PA PS-006990-L) | |
| 103T00000X Psychologist (Licence: PA PS-006990-L) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |