| NPI | 1649240490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS-005589-L) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: DE B1-0000528) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2007-07-08 |