| NPI | 1407890064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS003608L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS003608L) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: PA PS003608L) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2016-06-13 |