| NPI | 1740230937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS008059L) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS008059L) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2013-06-07 |