| NPI | 1811980063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS-006263-L) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS-006263-L) |
| 103TH0004X Psychologist, Health (Licence: PA PS-006263-L) | |
| 103T00000X Psychologist (Licence: PA PS-006263-L) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2017-12-04 |