| NPI | 1912352717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS018033) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS018033) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2022-02-11 |