| NPI | 1598792905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS.004179-L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS004179L) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2015-03-18 |