| NPI | 1326162603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS016202) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS-016202) |
| 103T00000X Psychologist (Licence: CO PSY-0005831) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2024-01-10 |