| NPI | 1386076446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017492) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA TPS030181) |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2018-02-02 |