| NPI | 1669425815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS009187L) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2007-07-09 |