| NPI | 1437306651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS-008949-L) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: PA PS-008949-L) |
| 103TC0700X Psychologist Clinical (Licence: PA PS-008949-L) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS-008949-L) | |
| 103TF0000X Psychologist Family (Licence: PA PS-008949-L) | |
| 103TH0004X Psychologist Health (Licence: PA PS-008949-L) | |
| 103TH0100X Psychologist Health Service (Licence: PA PS-008949-L) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: PA PS-008949-L) | |
| 103TR0400X Psychologist Rehabilitation (Licence: PA PS-008949-:) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2008-08-19 |