| NPI | 1609910587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS006817) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS006817) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS006817) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2016-09-12 |