| NPI | 1366584237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PA015382) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PA015382) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |