| NPI | 1356523716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS020166) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DE B10000777) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: DE B10000777) | |
| Enumeration Date | 2007-11-28 |
| Last Update Date | 2024-06-17 |