| NPI | 1396752853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS-006538L) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS006538L) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-03-10 |