| NPI | 1790451995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017706) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: PA 9318249) |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2021-08-18 |