| NPI | 1588640932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS002907L) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: PA PS002907L) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2007-07-08 |