| NPI | 1508853995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS006518L) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC002531) |
| 103G00000X Clinical Neuropsychologist (Licence: PA PS006518L) | |
| 103TH0100X Psychologist, Health Service (Licence: PA PS006518L) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2019-09-15 |