| NPI | 1568593143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017360) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 8696) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2017-01-26 |