| NPI | 1649313743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: PA MD033647L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA md033647l) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2010-12-10 |