| NPI | 1275740029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS002904-L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS002904L) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2021-10-01 |