| NPI | 1326473042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017681) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2020-03-30 |