| NPI | 1598792749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA 37PC00050500) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA 37PC00050500) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS007829L) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2025-09-11 |