| 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, Intellectual & 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 |