| NPI | 1932108420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS005722L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS005722L) |
| 103TC1900X Psychologist, Counseling (Licence: PA PS005722L) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS005722L) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2014-05-06 |