| NPI | 1447356605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS-005548-L) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MD 2275) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2024-03-28 |