| NPI | 1063629970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS002504L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35S100359300) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2009-08-17 |