| NPI | 1285962084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS018629) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: PA PS018629) |
| Enumeration Date | 2009-12-07 |
| Last Update Date | 2020-03-13 |