| NPI | 1770646705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS002059L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PSOO2059L) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2014-03-24 |