| NPI | 1750346136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS008322L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DE B1-0000522) |
| 103TC0700X Psychologist, Clinical (Licence: MD 03880) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2018-11-09 |