| NPI | 1437344173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 304056) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: PA PC004513) |
| 101YP2500X Counselor, Professional (Licence: PA PC004513) | |
| 103TC0700X Psychologist, Clinical (Licence: LA 1375) | |
| 103TC0700X Psychologist, Clinical (Licence: PA PS017349) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS017349) | |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2019-09-19 |