| NPI | 1487105060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA 17863) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS017863) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2023-12-19 |