| NPI | 1730248618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016860) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS016860) |
| 103TC0700X Psychologist, Clinical (Licence: FL PY7436) | |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2023-05-17 |