| NPI | 1669429254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS015405) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS015405) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS015405) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS015405) | |
| 103TF0000X Psychologist, Family (Licence: PA PS015405) | |
| 103TF0200X Psychologist, Forensic (Licence: PA PS015405) | |
| 103TH0100X Psychologist, Health Service (Licence: PA PS045405) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PA PS015405) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2010-08-09 |