| NPI | 1942489596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS005080L) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS005080-L) |
| 103TC0700X Psychologist Clinical (Licence: PA PS005080L) | |
| 103TC1900X Psychologist Counseling (Licence: PA PS005080L) | |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2018-12-12 |