| NPI | 1306612411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS020075) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS020075) |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2024-03-14 |