| NPI | 1669668992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016891) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: PA PS016891) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS016891) | |
| 103TC1900X Psychologist Counseling (Licence: PA PS016891) | |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2016-01-05 |