| NPI | 1366576860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS015638) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2011-09-07 |