| NPI | 1871080358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS018734) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 3565-57) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2019-08-14 |