| NPI | 1902856149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS002902L) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS002902L) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2013-06-06 |