| NPI | 1770179962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA ps018517) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PA ps018517) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: PA ps018517) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA ps018517) | |
| 103TC0700X Psychologist, Clinical (Licence: PA ps018517) | |
| Enumeration Date | 2020-12-12 |
| Last Update Date | 2021-06-02 |