| NPI | 1881090751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017709) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS017709) |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2023-12-16 |