| NPI | 1508354192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 05958) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS018430) |
| Enumeration Date | 2018-04-29 |
| Last Update Date | 2018-04-29 |