| NPI | 1881636355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS015698) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: WV 584) |
| 103TH0100X Psychologist, Health Service (Licence: PA PS015698) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2022-04-05 |