| NPI | 1639107998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS006213L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS006213L) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2014-08-11 |