| NPI | 1902163371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA 172Y1681) |
| Additional Taxonomies | 103TS0200X Psychologist School |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2012-04-23 |