| NPI | 1669069258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS020428) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS020428) |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2025-06-25 |