| NPI | 1487038972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017882) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS017882) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2022-04-20 |