| NPI | 1861425043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS005326L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS0053262) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2021-03-31 |