| 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 |