| NPI | 1568568715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS-002955-L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DE B1-0000480) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2007-07-08 |