| NPI | 1861438020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS-005710-L) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: PA PS-005710-L) |
| 103TC0700X Psychologist Clinical (Licence: PA PS-005710-L) | |
| 103TH0100X Psychologist Health Service (Licence: PA PS-005710-L) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2023-09-26 |