| NPI | 1457445470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016614) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW010940L) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-10-06 |