| NPI | 1538573936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DE B1-0001059) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS018559) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2026-07-23 |