| NPI | 1811106263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS004428L) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PA PS004428L) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS004428L) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS004428L) | |
| 103TF0000X Psychologist, Family (Licence: PA PS004428L) | |
| 106H00000X Marriage & Family Therapist (Licence: PA PS004428L) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2025-09-11 |