| NPI | 1851407357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS002934L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS002934-L) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS002934-L) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2024-11-20 |