| NPI | 1801077011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS016327) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PSY10000023) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2025-03-10 |