| NPI | 1477732105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA ps004853L) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: PA ps004853L) |
| 103TH0004X Psychologist, Health (Licence: PA Ps004853L) | |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2007-10-30 |