| NPI | 1427299809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS015026) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS015026) |
| 103T00000X Psychologist (Licence: CT 001952) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CT 001952) | |
| 103TC0700X Psychologist, Clinical (Licence: CT 001952) | |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2009-03-16 |