| NPI | 1790902468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS008122L) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS008122L) |
| 103T00000X Psychologist (Licence: PA PS008122L) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: PA PS008122L) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS008122L) | |
| 103TF0200X Psychologist, Forensic (Licence: PA PS008122L) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PA PS008122L) | |
| 103G00000X Clinical Neuropsychologist (Licence: PA PS008122L) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2012-11-26 |