| NPI | 1407068836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS002329L) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: PA PS002329L) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS002329L) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: PA PS002329L) | |
| Enumeration Date | 2007-05-06 |
| Last Update Date | 2007-07-14 |