| NPI | 1932135753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS015465) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS015465) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2012-04-02 |