| NPI | 1912395278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017704) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PA PS017704) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: PA PS017704) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: PA PS017704) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PA PS017704) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: PA PS017704) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS017704) | |
| 103TC0700X Psychologist, Clinical (Licence: PA PS017704) | |
| 103TF0000X Psychologist, Family (Licence: PA PS017704) | |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2015-05-29 |