| NPI | 1982351920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS019430) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS019430) |
| 103TC1900X Psychologist Counseling (Licence: PA PS019430) | |
| 103TH0100X Psychologist Health Service (Licence: PA PS019430) | |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2022-03-09 |