| NPI | 1659532745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS019160) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: PA SL008149) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2021-04-28 |