| NPI | 1891790358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS006323L) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: PA PS-006323-L) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2018-11-27 |