| NPI | 1326627936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS019226) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: PA PS019226) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2024-05-28 |