| NPI | 1417926197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PA PS003470-L) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS003470-L) |
| 103TC1900X Psychologist, Counseling (Licence: PA PS003470-L) | |
| 103TF0000X Psychologist, Family (Licence: PA PS003470-L) | |
| 103T00000X Psychologist (Licence: PA PS003470-L) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: PA PS003470-L) | |
| 103TS0200X Psychologist, School (Licence: PA PS003470-L) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2025-09-11 |