| NPI | 1831366186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS015537) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PA PS015537) |
| 103TF0200X Psychologist, Forensic (Licence: PA PS015537) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2016-05-05 |