| NPI | 1992891436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PA PS007789-L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS007789L) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2023-06-19 |