| NPI | 1417166646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS-006808-L) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC1900X Psychologist, Counseling | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 103TF0200X Psychologist, Forensic | |
| 103TH0100X Psychologist, Health Service | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2012-01-19 |